Provider Demographics
NPI:1023259918
Name:ITO, KAORI (MD)
Entity type:Individual
Prefix:DR
First Name:KAORI
Middle Name:
Last Name:ITO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KAORI
Other - Middle Name:
Other - Last Name:KUMAKURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:475 MAIN ST
Mailing Address - Street 2:APT #3E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0085
Mailing Address - Country:US
Mailing Address - Phone:617-459-3743
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-6861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program